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Impact of strut–vessel distance and underlying plaque type on the resolution of acute strut malapposition: serial optimal coherence tomography analysis after everolimus-eluting stent implantation

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Abstract

The consequences of acute strut malapposition in everolimus-eluting stents (EES) are unknown. This study investigated the impact of strut–vessel (S–V) distance and plaque type underneath acute strut malapposition on the mid-term vessel response in EES. Twenty-nine patients (35 EES) underwent optical coherence tomography (OCT) immediately after percutaneous coronary intervention and at 8-month follow-up. S–V distance and plaque type (lipid, calcified, or fibrous) underneath acute strut malapposition were evaluated. Follow-up OCT classified acute strut malapposition as persistent or resolved. The S–V cutoff value for predicting resolved strut malapposition and the incidence of intra-stent thrombi were determined. Among 569 cases of acute strut malapposition, involving 29,168 struts, 139 (24.4 %) were persistent. Mean S–V distance was significantly longer in persistent than in resolved strut malapposition (600 ± 294 vs. 231 ± 95 μm; P < 0.0001). S–V distance ≤380 μm was the best cutoff value for predicting resolved strut malapposition (sensitivity 93.5 %, specificity 69.8 %, area under curve 0.878). Acute strut malapposition with S–V distance ≤380 μm remained persistent more frequently over lipid/calcified than over fibrous plaques (lipid: 13.4 %, calcified: 18.2 %, fibrous: 4.2 %; lipid vs. fibrous, P = 0.001; calcified vs. fibrous, P = 0.02). Intra-stent thrombi were more frequent in stents with ≥1 persistent strut malapposition than in those without [4/11 stents (36.3 %) vs. 0/24 (0 %); P = 0.006]. Lipid and calcified plaque, together with S–V distance, affect the resolution of acute strut malapposition in EES. Persistent strut malapposition is associated with the presence of thrombi at follow-up, which could be the substrate for late stent thrombosis.

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan

    Takumi Inoue, Toshiro Shinke, Hiromasa Otake, Masayuki Nakagawa, Hirotoshi Hariki, Tsuyoshi Osue, Masamichi Iwasaki, Yu Taniguchi, Ryo Nishio, Noritoshi Hiranuma, Akihide Konishi, Hiroto Kinutani, Masaru Kuroda & Ken-ichi Hirata

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  1. Takumi Inoue
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  2. Toshiro Shinke
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  3. Hiromasa Otake
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  4. Masayuki Nakagawa
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  5. Hirotoshi Hariki
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  6. Tsuyoshi Osue
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  8. Yu Taniguchi
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  14. Ken-ichi Hirata
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Correspondence to Toshiro Shinke.

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Inoue, T., Shinke, T., Otake, H. et al. Impact of strut–vessel distance and underlying plaque type on the resolution of acute strut malapposition: serial optimal coherence tomography analysis after everolimus-eluting stent implantation. Int J Cardiovasc Imaging 30, 857–865 (2014). https://doi.org/10.1007/s10554-014-0422-z

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  • DOI: https://doi.org/10.1007/s10554-014-0422-z

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